Get Or Body Art Mobile Facility License Application

Filling out the OR Body Art Mobile Facility License Application online can be a straightforward process when you have clear guidance. This guide will walk you through each section of the application to ensure that you provide all necessary information accurately and comprehensively.

Follow the steps to efficiently complete your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the applicant information section, which includes your name, date of birth, social security number, and residential physical address. Ensure all required fields are completed accurately.
3. Next, provide information regarding your mobile facility. Include the name of the facility, the assumed business name, and the contact information, such as business telephone, vehicle details including make and license plate number.
4. Indicate whether you practice in this mobile facility and if you are closing a previous facility. If applicable, include your previous facility license number.
5. In the next section, confirm whether you have held any licensure, certification, or registration with the Health Licensing Office or any other state. If yes, list that information as requested.
6. Complete the payment section only if you are submitting payment by mail. Select the method of payment and fill in the required credit card details, ensuring that the Cardholder signature is provided.
7. Address the individual records questions honestly. You will be required to answer questions about any disciplinary actions or convictions, and provide supporting documentation if applicable.
8. Fill in the affirmative action – voluntary question if you choose to provide information for statistical purposes. This step is optional and should be completed at your discretion.
9. Input the facility’s initial service location address and indicate the specific time periods for each day that the mobile facility will be operational.
10. List the practitioners who will be providing body art services in your mobile facility, including their name and certification number. Ensure that each practitioner signs their entry to update the database.
11. Review all sections of the completed application for accuracy and make any necessary revisions. Confirm that all required documents and fees are enclosed, if applicable.
12. Finally, save changes, download, print, or share your completed form as needed. Retain a copy for your records.

Start completing your application online today for a smooth licensing process.